PDF(Pubmed)
Abstract：
Endoscopic procedures are routinely applied to cancer screening programs and surveillance. The preferred technique is usually deep sedation with propofol being a convenient agent allowing for a quicker patient recovery while maintaining a similar safety profile compared to traditional agents. However, adverse events, including respiratory depression and consequent undesirable cardiovascular side effects, may occur. The goal of this work is to evaluate the patient safety impact of adding capnography during endoscopic procedures under deep propofol sedation. Data were retrospectively collected from patients undergoing deep, procedural sedation for gastrointestinal (GI) endoscopy in October 2019 to January 2021 in a single Turkish university hospital. Included in the analysis were all adult patients classified by the American Society of Anesthesiologists (ASA) as I-IV, who were scheduled for GI endoscopy utilizing propofol alone or in combination. Data on 1840 patients were collected, of whom 1610 (730 pre- and 880 post-capnography implemention) met inclusion criteria. The primary outcome was a change in the composite incidence of mild oxygen desaturation (SpO2 75-90% for <60 s), severe oxygen desaturation (SpO2 < 75% anytime or <90% for >60 s), bradycardia (<60 ppm), and tachycardia (>25% from baseline). Without capnography, on average, 7.5 events of the primary endpoint were observed per 100 procedures and 2.9 with additional capnography monitoring (p < 0.001). A significant reduction was observed for mild oxygen desaturation, with a resulting odds ratio of 0.25 (95% CI 0.14 to 0.46). ASA I patients had the highest difference in combined incidence of any oxygen desaturation of 5.85% in the pre-capnography group and 0.64% in the post-capnography group. Although procedural sedation using propofol is not associated with severe adverse events, the incidence of composite adverse events could be reduced with the addition of capnography monitoring.
摘要：
内窥镜程序通常应用于癌症筛查程序和监测。优选的技术通常是深度镇静,丙泊酚是一种方便的药剂,允许更快的患者恢复,同时与传统药剂相比保持类似的安全性。然而,不良事件,包括呼吸抑制和随之而来的不良心血管副作用，可能发生。这项工作的目的是评估在深度丙泊酚镇静下在内窥镜手术期间添加二氧化碳描记对患者安全的影响。数据是回顾性收集的患者接受深，2019年10月至2021年1月在一家土耳其大学医院进行胃肠道（GI）内窥镜检查的程序性镇静。分析中包括美国麻醉医师协会（ASA）分类为I-IV的所有成年患者，计划使用异丙酚单独或联合进行胃肠道内窥镜检查的患者。收集了1840名患者的数据，其中1610人(730人实施二氧化碳监测前和880人实施后)符合纳入标准。主要结果是轻度氧饱和度的复合发生率的变化（SpO275-90％<60s），严重的氧饱和度（SpO2<75％随时或<90％>60s），心动过缓（<60ppm），和心动过速（基线>25%）。没有二氧化碳描记术,平均而言,每100例手术中观察到7.5例主要终点事件，另外进行二氧化碳监测时观察到2.9例（p<0.001）。轻度氧饱和度明显降低，结果比值比为0.25（95%CI0.14至0.46）。ASAI患者的任何氧饱和度降低的综合发生率差异最大，在二氧化碳描记术前组为5.85％，在二氧化碳描记术后组为0.64％。尽管使用异丙酚的程序性镇静与严重不良事件无关，增加二氧化碳监测可以降低复合不良事件的发生率.
